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SAN JOADUIN LOCAL HEALTH DISTRICT <br /> ERGROUND STORAGE TANK PROGRAM - FEE NORKSH <br /> F FACILITYlSITE NAME FACILITY CONTACT NAME <br /> . A Delta Truck Sales Kenneth Smith <br /> • C . <br /> I SITE PHONE t (with Area Code) <br /> L STREET ADDRESS 3437 Newton Road <br /> I <br /> T — STATE ZIP CODE 1 of TANK'S <br /> Y CITY Stockton CA at Site <br /> A APPLICANT/BILLING NAME APPLICANT CONTACT NAME <br /> P Delta Truck Sales Kenneth Smith <br /> P <br /> L APPLICANT PHONE t (with Area Code) <br /> I MAILING ADDRESS 3645 Cherokee (209 466-4161 �jte & Soil Re- xcav tion <br /> C <br /> A STATE ZIP CODE TYPE of APPLICATION work plan <br /> N CITY Stockton CA (Closure, Installation, et(.) <br /> T <br /> rFEE <br /> 00.00 each SITE ADDRESS per YEAR <br /> TOTAL <br /> 1986 1'387 1988 1989 <br /> $ <br /> 0 each TANK <br /> 0.00 1986 1987 1988 1989 <br /> A (�ulh pTy 1 by fee fur S <br /> C each year app!a able) <br /> L STATE SURCHARGE _ $Sb,00 each TANK (see CA HEALTH $ SAFETY CODE Sec 25281 for applica ,F�t <br /> l CE j N <br /> 6.0 <br /> T 1 Tanks__ __ 550 1986 1987 1988 1989 <br /> Y (enter amounl and year „ <br /> C PERMANENT CLOSURE (Reaoral or Closure-in-place) P41 <br /> L 1 Tanksx $90.Ud /SERV yfq� <br /> 0 CLOSURE FEE = $90.00 each TANK <br /> S <br /> U <br /> R TEMPORARY CLOSURE (Only allowed one time for up to two years) <br /> Ex $ <br /> TEMPORARY CLOSURE FEE (80.00 each TANK 1 Tanks----- $80.00 <br /> P PLAN CHECK (Installation or Repair) <br /> L <br /> A $ <br /> N PLAN CHECK FEE_t $30.00 each SUBMISSION/RESUBMISSION <br /> REPAIR — <br /> R 1 Tanks_____ x $110.00 $ <br /> E TANK REPAIR FEE = $110.00 each TANK <br /> P <br /> A <br /> 1 PIPING REPAIR/CLOSURE/REMOVAL (Fees are per hour, minimum one hour to be paid on plan submittal) <br /> R to moi SAMPLING � <br /> UNAUTHORIZED RELEASE EVALUATION CONSTRUCTIONreex,ava ion NSPECTION !C� <br /> (when applicable) INSPECTION work Ian consul <br /> FEE _ $30.00/hr FEE _ $35.00/hr 35.00 FEE = 135.00/hr 35.00 1 70.00 <br /> TOTAL DUE <br /> OFFICE USE ORIY <br /> WEEPS 1 COMP t LOC CODE DIST CODE AMOUNT DUE AMOUNT RCVD CHECK)!CASH I RCVD BY DATE RECEIVED IFERN11 1 <br /> rE 03 c ?0 ce' o3& — o-"�C/ Iwo- <br /> . ra <br /> • <br />